Cosmetic Procedures

Acne

Almost all cases of acne can be effectively treated. Treatment goals are to heal existing acne lesions, stop new lesions from forming, and prevent acne scars from developing.

Acne treatment aims to control one or more of the underlying causes of acne. For instance, topical retinoids, such as Differin, Retin A Micro or Tazorac, may help unclog sebaceous glands and keep pores open. Antibiotics may be used to fight the P. acnes bacteria. Isotretinoin (Accutane) or hormonal agents, such as birth control pills, may be used to reduce sebum (oil) production.

Benzoyl peroxide—This is found in many products including Clearasil and Proactiv. It is a mild antibiotic that kills the P. acnes bacteria. It is available in different concentrations. Higher concentrations are more likely to irritate the skin. It does not unclog blocked pores so is not as helpful for reducing whiteheads and blackheads.

Sulfur and salicylic acid—These have some mild ability to break down whiteheads and blackheads. This is found in many non-prescription products including Sensiclear.

Prescription

Topical retinoids (Differin, Epiduo, Retin A Micro, Tazorac, tretinoin, Ziana)—These are among the most effective and commonly used prescription acne medications. Topical retinoids are unique in their ability to unclog swollen pores. They may be used alone for mild acne or combined with other medications for moderate to severe acne. They may also be recommended for long-term use, even after the acne is under control, to keep the skin clear.

Topical antibiotics—Antibiotics applied to the skin, such as clindamycin (Clindagel) and erythromycin, kill the P. acnes bacteria that leads to inflammation.

Oral antibiotics—These medications, which include tetracycline, doxycycline (Adoxa, Doryx), and minocycline (Dynacin, Solodyn), act systemically and can reach bacteria in the deep layers of the dermis. They are also used for their anti-inflammatory effects.

Anti-androgen drugs—Some drugs used for other medical conditions are known to reduce androgen levels, such as spironolactone (Aldactone). These may be used in some cases of acne.

Isotretinoin (Accutane, Sotret)—Isotretinoin remains the most effective treatment for severe acne or acne that does not respond to other treatments. Isotretinoin treats all causes of acne: excess sebum, clogged pores, bacterial overgrowth, and inflammation. Most patients take the medicine for 15-to-20-week periods that may be repeated if necessary. Treatment requires monthly office visits, monthly lab tests, and strict contraception. It is critical that women of child-bearing age do not get pregnant while taking isotretinoin because of the serious risk of birth defects. The iPledge program was developed to reduce the likelihood of birth defects and other side effects.

Many of these acne medications have side effects, such as burning, redness, and irritation. With some medicines, such as topical retinoids, these side effects usually decrease or go away after the medicine is used for a period of time. If side effects are severe or don't go away, tell your doctor.

Your doctor will recommend an acne treatment regimen based on these factors:

Severity of your acne. Mild acne may respond well to a topical retinoid alone. Moderate acne may respond better to a combination of topical retinoid with an antibiotic or other medication. Severe acne with scarring may need treatment with an oral retinoid (Accutane, Sotret).

Results of previous treatments. Medications may be added in a step-wise fashion, only if previous treatments are found to be ineffective.

Degree of scarring. More aggressive therapies may be started earlier if acne scars have already started developing.

Gender. Some treatments are available only for females, such as birth control pills.

Whatever your treatment plan, it is important that you give it enough time to work. This may mean waiting 6 to 8 weeks to see results. While the older acne lesions are healing, the medication is hard at work keeping new lesions from forming. Staying on your medication is the most important step to getting acne under control.